De Deken Julie, Rex Steffen, Monbaliu Diethard, Pirenne Jacques, Jochmans Ina
1Laboratory of Abdominal Transplantation, Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium.2Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium.3Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium.4Department of Anaesthesiology, University Hospitals Leuven, Leuven, Belgium.
Crit Care Med. 2016 Sep;44(9):e886-96. doi: 10.1097/CCM.0000000000001717.
Noble gases have been attributed to organ protective effects in ischemia reperfusion injury in a variety of medical conditions, including cerebral and cardiac ischemia, acute kidney injury, and transplantation. The aim of this study was to appraise the available evidence by systematically reviewing the literature and performing meta-analyses.
PubMed, EMBASE, and the Cochrane Library.
Inclusion criteria specified any articles on noble gases and either ischemia reperfusion injury or transplantation. In vitro studies, publications without full text, review articles, and letters were excluded.
Information on noble gas, organ, species, model, length of ischemia, conditioning and noble gas dose, duration of administration of the gas, endpoints, and effects was extracted from 79 eligible articles. Study quality was evaluated using the Jadad scale. Effect sizes were extracted from the articles or retrieved from the authors to allow meta-analyses using the random-effects approach.
Argon has been investigated in cerebral, myocardial, and renal ischemia reperfusion injury; helium and xenon have additionally been tested in hepatic ischemia reperfusion injury, whereas neon was only explored in myocardial ischemia reperfusion injury. The majority of studies show a protective effect of these noble gases on ischemia reperfusion injury across a broad range of experimental conditions, organs, and species. Overall study quality was low. Meta-analysis for argon was only possible in cerebral ischemia reperfusion injury and did not show neuroprotective effects. Helium proved neuroprotective in rodents and cardioprotective in rabbits, and there were too few data on renal ischemia reperfusion injury. Xenon had the most consistent effects, being neuroprotective in rodents, cardioprotective in rodents and pigs, and renoprotective in rodents.
Helium and xenon show organ protective effects mostly in small animal ischemia reperfusion injury models. Additional information on timing, dosing, and comparative efficacy of the different noble gases, as well as confirmation in large animal models, is needed before designing clinical trials.
在包括脑缺血、心脏缺血、急性肾损伤及移植等多种医学病症的缺血再灌注损伤中，惰性气体已被证实具有器官保护作用。本研究旨在通过系统回顾文献并进行荟萃分析来评估现有证据。
PubMed、EMBASE及Cochrane图书馆。
纳入标准为指定任何关于惰性气体与缺血再灌注损伤或移植的文章。体外研究、无全文的出版物、综述文章及信函均被排除。
从79篇符合条件的文章中提取有关惰性气体、器官、物种、模型、缺血时长、预处理及惰性气体剂量、气体给药持续时间、终点指标及效应的信息。使用Jadad量表评估研究质量。效应量从文章中提取或向作者索取，以便采用随机效应方法进行荟萃分析。
已对氩气在脑、心肌及肾缺血再灌注损伤中的作用进行了研究；氦气和氙气还在肝缺血再灌注损伤中进行了测试，而氖气仅在心肌缺血再灌注损伤中进行了探索。大多数研究表明，在广泛的实验条件、器官及物种中，这些惰性气体对缺血再灌注损伤具有保护作用。总体研究质量较低。仅在脑缺血再灌注损伤中对氩气进行了荟萃分析，且未显示出神经保护作用。氦气在啮齿动物中显示出神经保护作用，在兔子中显示出心脏保护作用，而关于肾缺血再灌注损伤的数据太少。氙气具有最一致的效应，在啮齿动物中具有神经保护作用，在啮齿动物和猪中具有心脏保护作用，在啮齿动物中具有肾脏保护作用。
氦气和氙气主要在小动物缺血再灌注损伤模型中显示出器官保护作用。在设计临床试验之前，需要有关不同惰性气体的时机、剂量及比较疗效的更多信息，以及在大型动物模型中的验证。
